Episode 3: Sedation Depth Why going too deep can hurt.
The Critical Care Practitioner
Release Date: 08/21/2025
Episode 6: Guidelines and the Future of Sedation in Critical Care
The Critical Care Practitioner
Sedation practices in the ICU have evolved dramatically over the past decade — but are we truly following the evidence? In this episode of The Critical Care Practitioner Podcast, Jonathan takes you through the key milestones in sedation guidance, the persistent gap between recommendations and real-world practice, and the emerging shift toward human-centered, wakeful care. What You’ll Learn in This Episode: PAD Guidelines (2013) & beyond: How Barr et al. and later ATS/CHEST summaries shaped modern sedation practice. Where we fall short: Why deep sedation is still common and...
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Episode 5 — Sedation Choices: Benzos, Propofol, Dexmedetomidine
The Critical Care Practitioner
Overview In this episode we explore the three main sedatives used in critical care and how to choose the right agent for the right patient. Highlights Benzodiazepines: once the workhorse of ICU sedation, but now linked to more delirium and longer ventilation. Still useful in alcohol withdrawal and seizures. Propofol: rapid on/off, easy to titrate, helpful for daily sedation holds and neuro assessments. Watch for hypotension, lipid issues, and the rare risk of infusion syndrome. Dexmedetomidine: provides light, cooperative sedation with minimal respiratory depression and less delirium,...
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Episode 4: Sedation Protocols Turning knowledge into practice final
The Critical Care Practitioner
We’ve explored the history of sedation in ICU, the impact of daily awakening trials, and the risks of deep sedation. In this episode, we focus on how to embed that evidence into practice — through the use of structured sedation protocols. Protocols don’t just provide guidance; they transform everyday ICU culture, reduce variation in care, and improve outcomes. But implementing them isn’t always easy. This episode explores the why, what, and how of sedation protocols — and the cultural shift they demand. What You’ll Learn in This Episode 🏥 Why protocols were needed: how...
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Episode 3: Sedation Depth Why going too deep can hurt.
The Critical Care Practitioner
Episode 3 – Sedation Depth: How Deep Is Too Deep? In this third part of our sedation series, we explore one of the biggest game-changers in ICU practice: sedation depth. For years, the approach was “sedate and stabilise” — often to deep levels. But mounting evidence tells a different story: early deep sedation, especially in the first 48 hours, worsens outcomes. 📉 The risks of deep sedation Higher hospital and 180-day mortality (SPICE study, Shehabi et al., 2013) Longer time to extubation and ICU stay Increased long-term disability 🧠 Sedation and delirium Strong links...
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Episode 2 The sedation hold game changer or risky routine?
The Critical Care Practitioner
In this episode, I explore the origins and evolution of the daily sedation hold — also known as the spontaneous awakening trial (SAT) — one of the most influential shifts in ICU sedation practice. I unpack the key trials that demonstrated SATs could safely reduce ventilation time and ICU stay, and examines how these findings became standard care. But it's not all straightforward — SATs come with implementation challenges, especially when protocols are already in place. Key topics: The evidence behind daily sedation interruption How SATs reduce ventilation and improve survival Why...
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Episode 1 A short history of sedation in ICU
The Critical Care Practitioner
In this episode, I explore how sedation practices in critical care have evolved over time — from the routine use of deep, continuous sedation to the early evidence that challenged it. You'll hear about pivotal studies that revealed the risks of over-sedation, the emergence of structured sedation protocols, and the beginnings of a culture shift toward lighter, more patient-centered care. Key topics: The rise of continuous sedation in early ICU care Landmark studies questioning deep sedation Early implementation of sedation protocols How sedation culture began to change Kress...
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CCP Podcast: Whats an ITU stay like for patients families?
The Critical Care Practitioner
This is a conversation I had with Francesca Trotta, a nurse from Rome who is at the last stages in her PhD. This was at the BACCN conference in Aberdeen in 2024.
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CCP Podcast: Working in war zones and Disaster Areas
The Critical Care Practitioner
This is a chat I had with David Wightwick who is the CEO of UK Med a humanitarian medical aid charity. This happened at the BACCN 2024 conference in Aberdeen.
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Are ACCPs here to stay?
The Critical Care Practitioner
This is a conversation I had with professor Tim Buchman who is Professor of Surgery and founding director at the Emory Centre for Critical Care in the US. We discuss the advent of Advanced Practice in the US and how it will inform the same developments in the UK
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CCP Podcast: AI with Aarti Sarwal
The Critical Care Practitioner
AI is here! How will it effect us and how can we use it, or not use it to help with our work? Aarti gives some easy to understand explanations of the key concepts.
info_outlineEpisode 3 – Sedation Depth: How Deep Is Too Deep?
In this third part of our sedation series, we explore one of the biggest game-changers in ICU practice: sedation depth.
For years, the approach was “sedate and stabilise” — often to deep levels. But mounting evidence tells a different story: early deep sedation, especially in the first 48 hours, worsens outcomes.
📉 The risks of deep sedation
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Higher hospital and 180-day mortality (SPICE study, Shehabi et al., 2013)
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Longer time to extubation and ICU stay
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Increased long-term disability
🧠 Sedation and delirium
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Strong links between deep sedation and ICU delirium (Ely et al., 2005; Tanaka et al., 2014)
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Delirium predicts worse survival and cognitive outcomes
🏥 Impact on ventilation and recovery
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More time ventilated
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Higher risk of infections
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Longer ICU and hospital stays
🛠️ Strategies for safer practice
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Set clear sedation targets (RASS –1 to 0)
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Protocolised, nurse-driven sedation adjustment
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Start light and reassess frequently
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Deep sedation only when clearly indicated (e.g., severe ARDS, TBI, refractory agitation)
Takeaway:
Early deep sedation is a modifiable risk factor. The mantra is simple: “light unless otherwise indicated.” Less really is more — and safer.